Homeland security, ticketless travel and the patient experience: What healthcare can learn from volume-based consumer industries

Over the last 30 years, the airline industry has increased passenger volumes by 300 percent while decreasing the average inflation-adjusted ticket cost by 40 percent. Sound like a success story that healthcare could benefit from?

[The following content is sponsored by CannonDesign.]

Never in history has understanding patients' consumer traits played such a pivotal role in successful healthcare organizations. For health systems, growing a profitable patient, aka "consumer" base, while cutting the costs associated with care has become essential. At the heart of this challenge is developing patient experiences tailored to meet evolving needs and expectations of healthcare consumers. A multitude of studies provide strong evidence that the patient experience impacts treatment compliance, which ultimately effects clinical outcomes (Price et al., 2014). Beyond this, we also know that satisfied patients are far less likely to pursue litigation for outcomes they perceive as undesirable (Stelfax et al., 2005). At the same time, removing inefficiencies by accelerating patient flow and processes to create a streamlined delivery that respects patient time and enriches provider productivity is one of the most direct ways to reduce costs — optimizing the return on investment of both space and human resources.

Although healthcare is changing rapidly, the key patient priorities remain familiar: convenience, cost, experience and quality. Healthcare executives hoping to lead their organizations to success in this hypercompetitive industry would be wise to explore how other industries have responded to the very same challenges, and succeeded. Commercial aviation is one industry that has leapt to the forefront of utilizing experiential design to reimagine the consumer experience while optimizing efficiency.

Increasing capacity by embracing technology
A brilliant example of managing the consumer experience in action can be seen with the Department of Homeland Security's Immigration and Customs Enforcement (ICE) division, which has taught us that you don't need massive amounts of space or staff to create an accessible, intuitive experience; you just have to think wisely about how you can use your resources differently. Responding to the increasing number of international travelers entering the United States coupled with increasingly sophisticated screening requirements, ICE introduced Global EntryTM to expedite the process for travelers willing to pay a fee and submit to additional screening. The model fast-tracks certain customers, which has reduced border crossing at some locations from over an hour to under a minute. Similar strategies have now been employed for all passengers entering the United States vis-à-vis automated passport kiosks.

An example of employing a similar strategy of queuing theory and experiential design can be seen at Hamad Medical Center in Doha, Qatar. Hamad Medical Corporation is currently designing a new emergency department in preparation for the influx of patients expected during the 2022 FIFA World Cup games. The Hamad ED is expecting almost a half million annual visits, with arrival patterns that involve dozens of low-acuity patients arriving simultaneously by bus. Leaders at Hamad were challenged to identify new solutions for efficiently managing patient volumes without adding significant space or redirecting staff resources to non-clinical functions.

Imagine an ED where long registration lines and overflowing waiting areas are replaced by self-service kiosks and/or small registration spaces — similar to the experience many travelers are now having when entering or re-entering the United States utilizing automated border control technologies and small, private registration lanes similar to passport control stations. Spaces that once supported no more than three or four patient arrivals simultaneously will now support up to three times as many patients.  This type of innovation, if executed thoughtfully, has the potential to increase throughput, decrease wait times and respond to evolving patient expectations with respect to interaction with automated technologies.

However, making it through registration and avoiding long wait times is only a small segment of the overall patient experience — there are many other aspects of care that inform a patient's perception. Here again we can look to the airline industry. Some practices established over the last couple of decades — impacting everything from booking to check-in, checking luggage, obtaining boarding passes and seat changes — have made the process more efficient and customizable to the individual consumer, while at the same time increasing throughput without increasing cost. This could be revolutionary if applied to healthcare; but there are also some pitfalls that could be detrimental.

Eliminating touch-points
Many years ago, the airline industry realized that it needed to improve the experience of passengers as they move through the airport. Over the course of the last few decades, we have seen a transformation from having multiple, mandatory touch-points and interactions with the airline — the phone call to the ticket agent, printing and delivering a ticket, needing to visit a check-in counter, baggage drop, security, gate check-in and, finally, the in-flight experience — to the most innovative models today where you can do everything online beforehand and end up in your plane seat with barely any face-to-face interactions. Some experts predict that by 2025, your first interaction with the airline will be at the gate thanks to advances in biometric and genetic technologies that automate and expedite information retrieval (Future Travel Experience, 2013). When you start to compare this to the healthcare setting — scheduling, registration, check-in, waiting, rooming, vital check, clinical appointment, billing, check-out, etc. — you quickly realize that healthcare hasn't made it nearly as far in streamlining the touch-points. Most organizations have only made it as far as online scheduling — and some not even that. However, there is great opportunity to incorporate innovations similar to those of airlines with the potential to obtain similar results.

To start with, it's important for healthcare organizations to start to define what absolutely needs to be done within the walls of their environment versus what can be digitally expedited. Facing increasing volumes and pressures to cut extraneous costs, leading organizations are starting to tackle this in some pretty meaningful ways.

The University of Minnesota Health — a collaboration between University of Minnesota Physicians and University of Minnesota Medical Center — is currently building a new ambulatory care center that will serve over half a million patient encounters annually. The building will include space for multidisciplinary clinics, a cancer center, ambulatory diagnostics, executive health and other programmatic elements. With an eye toward innovation, University of Minnesota Health has utilized this capital investment as a stimulant to rethink everything, instead of taking the easy road of simply moving their existing processes into a better looking space.

From day one, the University of Minnesota Health leadership has been examining how they can transform the patient experience while optimizing throughput and reducing cost. One of their main goals is to minimize the number of touch-points on the front-end of the patient experience — and they are leveraging both technology and an evolution of traditional healthcare roles to help them do that. For example, pre-appointment information and pertinent data collected before the patient arrives will be pushed all the way to patient concierges to eliminate patient queuing. Traditional reception and registration staff will be replaced with cross-trained personnel who will both greet and ideally escort patients directly to their exam rooms. Post-exam activities will occur efficiently in the exam room, including valet car retrieval notice — allowing patients to leave their exams and move directly to their cars, which will be waiting at a dedicated valet exit.

Communication and transparency take center stage
While it can be exciting to discuss vast possibilities or innovations and insights that can applied from the commercial aviation industry – it is also wise to recognize that historically the airline industry has been anything but a leader in customer satisfaction. Healthcare is facing the same challenge as the airline industry has over the last several decades — how to increase volume while reducing cost. If healthcare goes the way of leveraging technology to minimize touch-points and expedite throughput, the final lesson learned is one the airline industry has recently employed to recover from the perception of a poor experience…transparency. Delivering a predictable, on-time, incident-free clinical experience is a challenge in healthcare as schedules can be upset by variables too numerous to list. Travel has the same dilemma.  

Again, taking a proactive approach the travel industry is pushing information to each traveler. Today you can download a free app that lets you see exactly where your plane physically is at any moment, and if it is on time or not. The most innovative carriers even push you alternate options if your original flight is disrupted. They are relying on transparency of information to make the unpredictable…acceptable. Imagine if you were texted that your physician is running 60 minutes late an hour before you had to leave for your appointment. A service recovery moment could be turned into a positive event. Take this one step further — offer the patient an alternate provider who has capacity at the original time, or the ability to reschedule at the touch of a button. The consumer has regained control, and you improved their experience and likely decreased your cost.

There are as many pitfalls to be avoided and benefits to reap in leveraging new technology and process improvements to enhance the patient visit. The healthcare industry has no other option but to leap ahead in its efforts to optimize experience and efficiency — leveraging some lessons learned from the airline industry is a good place to start.


Manuel Hernandez, MD, Principal, is leader of CannonDesign’s Health Advisory Services and a member of the Health Practice core leadership team. A practicing emergency medicine physician, Dr. Hernandez is an internationally-recognized thought leader on clinical futures.
Michael Pukszta, Principal, is an integral member of CannonDesign’s Health Practice core leadership team who has worked alongside many of the nation’s top healthcare institutions providing trusted direction on how to flexibly plan and adapt for tomorrow’s healthcare reality.



Future Travel Experience. (2013, September 12). FTE Think tank outlines vision for airport of 2025 and calls for industry collaboration. Retrieved from: http://www.futuretravelexperience.com/2013/09/fte-think-tank-outlines-vision-airport-2025-calls-industry-collaboration/
Price, R. A., Elliott, M. N., Zaslavsky, A. M., Hays, R. D., Lehrman, W. G., Rybowski, L., ... & Cleary, P. D. (2014). Examining the role of patient experience surveys in measuring health care quality. Medical Care Research and Review, 71(5), 522-554.
Stelfox H.T., Gandhi T.K., Orav E.J., Gustafson M.L. (2005) The relation of patient satisfaction with complaints against physicians and malpractice lawsuits. The American Journal of Medicine, 118(10), 1126-1133.
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